Source: Daily News
By John Rhee
“It’s my life; why won’t you just let me die?” We had spent much time together during the weeks on my psychiatry rotation and had grown fairly close. Yet it wasn’t our bond that made her words so hard to hear. It was because she wasn’t dying; she was depressed.
Of course, at the time, none of my supervising psychiatric physicians acceded to her wish to end her life. On the contrary, they worked hard to help her see the value in her life with a combination of psychotherapy, counseling and medication.
Current practice demands that patients get such care — even if they refuse. One of my professors described a case where she had to “forcefully admit” a patient who had expressed the desire to kill herself. That patient eventually expressed her gratitude — but only months afterward. And in fact, even in my brief rotation, there were moments where my patient and I spoke of her dreams, goals, and hopes upon leaving the hospital.
Through such experiences, I have been taught and have internalized that directly denying a patient’s wishes under such circumstances is considered to be good practice. In fact, it is not only good practice, it is the current standard of care.
Soon that may change. The New York Medical Society is set to survey its members on attitudes about assisted suicide — which several state associations did prior to removing their opposition to assisted suicide — and legislation has been introduced in New York that would allow physicians to prescribe a lethal dose of medicine to terminal patients who wish to end their own lives.
Many such patients can be depressed. In fact, in Oregon, where assisted suicide has been legal since 1997, a cross-sectional study of 58 patients requesting assisted suicide in 2006 found that fully 25% were depressed.
Yet the proposal introduced in New York does not require screening, let alone subsequent treatment, for clinical depression when present. The proposed legislation requires only that a patient be assessed for competency.
One might think such a departure from the current standard of practice to be inconceivable. However, such indifference to treatment of patients with mental health problems and who want to be dead is already happening.
In the most recent report from the Oregon Health Authority, out of 133 patients who died of assisted suicide in 2016, only 3.8% of assisted suicide patients are referred for psychiatric assessment. In some parts of Europe, the problem of non-treatment is even worse.
As a medical student, I have personally witnessed the benefits of our current practice — a practice that treats all patients consistently, whether labeled terminal or not. Will we continue to treat patients with depression equally or will we accept that it is natural to want to be dead given some life circumstances?
And if we will help a patient take an overdose to kill themselves when they are predicted to have six months to live, why not if they are predicted to live longer? Or if they are younger, like my patient? Or if they have a chronic disease, like heart failure?
In fact, some doctors in Oregon already want to expand the practice of assisted suicide, and this past year legislators introduced a bill to expand the practice to those patients expected to live up to 12 months (from the existing limit of six months). This is not simply a slippery slope; it is the logical next step when the interests of a person are more highly valued than the person him or herself.
Six months to live is an arbitrary length of time. Indeed, in such scenarios, one could argue that there is a moral imperative to allow even easier access to assisted suicide for those who are in pain and despair yet have a longer period of predicted life and suffering remaining.
Some would have us join Dutch doctors in ensuring that we honor patient autonomy above our current credos, “I will do good” and “I will do no harm.”
What drew me to medicine, and what I hope draws future generations, was the responsibility to protect vulnerable, hurting patients — including those who need and deserve our help from harming themselves. New York now threatens that precious contract.
Rhee holds a master’s degree in public health and is a fourth-year medical student at the Icahn School of Medicine at Mount Sinai.